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Risk factors for neurotoxicity in newborns with hyperbilirubinemia

Risk factors for neurotoxicity in newborns with hyperbilirubinemia
Gestational age <38 weeks and this risk increases with the degree of prematurity
Albumin <3.0 g/dL*
Alloimmune HDN (ie, positive DAT), G6PD deficiency, or other hemolytic conditions
Sepsis
Significant clinical instability in the previous 24 hours
This table summarizes the main risk factors for neurotoxicity in newborns with hyperbilirubinemia as recognized in the AAP clinical practice guideline for management of neonatal hyperbilirubinemia. These risk factors are used to determine the hour-specific thresholds for phototherapy and exchange transfusion. Refer to separate UpToDate content on neonatal hyperbilirubinemia for additional details.

HDN: hemolytic disease of the newborn; DAT: direct antiglobulin test; G6PD: glucose-6-phosphate dehydrogenase; AAP: American Academy of Pediatrics.

* It is not necessary to routinely check albumin levels in healthy term and late preterm newborns. Serum albumin levels may be useful if there are concerns of impaired bilirubin-albumin binding (eg, newborns with extreme hyperbilirubinemia, preterm neonates, infants with certain underlying conditions [eg, congenital nephrotic syndrome], and those treated with certain medications [eg, ceftriaxone]). If a newborn has a serum albumin level checked for any reason and the level is found to be low, this should be factored into treatment decisions. In addition, newborns with bilirubin levels that are approaching the hour-specific threshold for exchange transfusion should have a serum albumin level checked to assess risk of neurotoxicity. Calculation of the bilirubin-albumin ratio may modify the threshold for intervention. Refer to separate UpToDate content on management of neonatal hyperbilirubinemia for additional details.

¶ A negative DAT does not exclude the diagnosis of alloimmune HDN, particularly in the setting of ABO incompatibility. Further investigation may be warranted if there is clinical concern for hemolysis (eg, early onset of jaundice). Refer to separate UpToDate content on alloimmune HDN for additional details.
Reproduced with permission from Pediatrics, Vol. 150, Page e2022058859, Copyright © 2022 by the AAP.
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